Background Check Requirements for Home Care Workers in Texas

Pre-hire verification rule. 26 TAC § 558.247 requires a HCSSA, before hiring an unlicensed applicant or before first face-to-face client contact, to search the Nurse Aide Registry (NAR) and Employee Misconduct Registry (EMR) and to conduct a criminal history check in compliance with Texas Health and Safety Code Chapter 250. Source ↗

Chapter 250 criminal checks. Health & Safety Code ch. 250 authorizes name/DOB-based checks through the Texas DPS secure website (or FACT fingerprinting where used); agencies may not employ unlicensed persons with convictions listed in § 250.006 that bar employment, some permanently and some for five years after conviction. Source ↗

Employee Misconduct Registry. The EMR (Health & Safety Code ch. 253; 26 TAC ch. 561) lists unlicensed staff with substantiated findings of abuse, neglect, exploitation, or misappropriation; a listed person is permanently unemployable by HCSSAs and other covered LTC providers. Source ↗

Annual re-verification. Agencies must re-search the NAR and EMR at least every 12 months for unlicensed employees with face-to-face client contact (hires on or after September 1, 2009), a frequently cited survey deficiency. Source ↗

Out-of-state history. DPS name-based checks cover Texas records only; HHSC guidance directs agencies to obtain other states' criminal history when the applicant has lived outside Texas, and Medicaid programs layer OIG exclusion screening on top. Source ↗

License categories. The rules cover all HCSSA license categories — licensed home health, licensed and certified home health, hospice, and personal assistance services (PAS) — so non-medical attendants are screened on the same basis as skilled staff. Source ↗

No universal federal mandate. There is no federal law requiring criminal background checks for private-pay home care workers; requirements are set state by state. HHS OIG found wide variation in state home health background check requirements, and Medicare Conditions of Participation for home health agencies defer to state law on screening. Source ↗

National Background Check Program (ACA Section 6201). Section 6201 of the Affordable Care Act created the CMS National Background Check Program, which awarded grants to more than 25 states to build fingerprint-based, comprehensive background check systems for direct patient access employees of long-term care providers, including home health agencies and personal care providers. Source ↗

FCRA obligations. When an agency uses a consumer reporting agency (third-party background check vendor), the federal Fair Credit Reporting Act requires a standalone written disclosure, the applicant's written authorization, and the pre-adverse action / adverse action notice process (copy of the report and Summary of Rights) before rejecting a candidate based on the report. Source ↗

OIG exclusion list (LEIE). Home care providers that bill Medicare or Medicaid must not employ or contract with individuals excluded from federal health care programs. HHS OIG maintains the List of Excluded Individuals/Entities (LEIE); CMS and state Medicaid agencies expect screening at hire and monthly thereafter, and payments tied to excluded persons are subject to recovery and civil monetary penalties. Source ↗